Why do teenage suicides happen in clusters?

Glenn Saxe, MD, FRCP, director of Children’s Hospital Boston’s Center for Refugee Trauma and Resilience and director of the Children’s Hospital Youth Centered Suicide Prevention Program, responds to recent studies coming out of Columbia University that investigate reasons why suicide can be attractive to teenagers and young adults, and why suicide “clusters” (3 or more suicides in a row) are more common in young people.

The researchers at Columbia cite social modeling as a factor for suicide clusters in teenagers. What is social modeling?

Although many factors account for suicide in teenagers, social modeling is an important one. Social modeling refers to the way an individual may conform their behavior to what they observe in others. This is particularly important in adolescent development. Adolescence is a time when teenagers are struggling with figuring out who they are and who they want to become. They’re trying to find an identity that’s comfortable for them and amongst the most important places they search for identity is within their peer group. This works at both the individual and at the group level. Teens identify and model their behavior after other kids they admire. Different peer groups themselves offer different identities for teens (e.g. the jocks, the preps, the goths, the gangsters). Although suicide clusters are rare, this social modeling process facilitates its occurrence.

Can social modeling really make suicide look attractive to teenagers?

It can. Our group worked with one terrible suicide cluster in South Boston during the late-1990s. This cluster began with the suicide of a very popular high school student. He was a kid who everyone knew and admired. His funeral was a big community event and there was tremendous affection for him expressed by many in the high school and the community. In a community as tight as South Boston, this affection and grief left a deep impression on many kids and adults. Other teens began to attempt suicide. Tragically, within an 18-month period, there were six suicides, plus 48 potentially lethal attempts and more than 30 non-lethal attempts. I’m not in any way saying that community grief caused this epidemic, but it was a part of the conditions at that moment in time that contributed to its occurrence.

Are there any other co-factors that would make a teenager more prone to suicide?

Depression is a big one. A student is who is feeling sad and hopeless may be having his own suicidal thoughts, and if people he may admire carry out a suicidal act, that may push him over the edge. Another big risk factor is substance abuse. If someone has an impulse to harm themselves, drugs and alcohol may diminish their ability to restrain themselves from acting impulsively. Trauma from violence within the community or violence within the home is also a risk factor.
A common pathway for many of these risk factors is an individual feeling alone and isolated with the belief that no one else will understand, no one else will be able to help, or seeking help will lead to criticism and even abuse. It is the emotion associated with aloneness that is a powerful driver of suicidal behavior. In a way, this relates to the development of suicide clusters as the identification with others as a form of connection in teens who feel desperate for connection.
Our work with the suicide cluster in the South Boston high schools led to our development of a suicide prevention program called Students for Students (formerly known as the Youth-Centered Suicide Prevention Program). One of the most important components of this program is developing connections between adolescents who are at risk with other students that are seen as role models within the school. The motto of our program is “Never Worry Alone”. These words are put on posters throughout the school and are worn on the t-shirts identifying our Peer Leaders.

Why are some teenagers’ suicides isolated incidents while other suicides tend to cluster?

People often ask, “Why did someone kill themselves?” Usually, there’s no one answer. It’s usually a complex mix of risk factors that converge at a tragic point in time. For example, consider the situation of a teen who is being abused at home and begins to develop depression. The experience of abuse and the symptoms of the depression lead to the teen’s feeling increasingly isolated, alone and beyond help. The teen may even feel that if he or she seeks help the abuse will worsen. In the teen’s state of isolation and desperation he or she considers suicide. On a given day, the teen learns about another kid in school who either commits suicide or makes an attempt. After school the teen goes to his or her room and consumes a bottle of Tylenol (as did the teen who committed suicide). I give this example because the story is similar to a number of adolescents with whom I have worked and because it illustrates the complexity of the nature of suicide.
Risk factors can work together either for an isolated student or within a social network of students. We know a lot about risk factors but predicting suicidal acts is very difficult. There is no study I know of that was able to predict a suicide cluster.

How sensitive should the news media be in covering teenage suicides?

Teenagers are hungry for information that may help them form a sense of identity. They are looking for messages, from wherever they may come, that will help them to figure out who they are and who they want to be. In this context, media communication about a teen’s suicide can be very powerful, especially if it fosters the identification of a vulnerable kid with one who has committed suicide.
A media focus that aims to destigmatize mental illness and seeking help for emotional problems is important. Factual, non-dramatic media portrayals that provide information of where and how to get help can be helpful in the wake of a teen’s suicide.

If a friend of your teenage son or daughter commits suicide, how can a parent help?

A parent’s communication in words and actions of “Never Worry Alone” is the most powerful form of communication. This requires that a parent is attuned to the emotional state of their child (particularly what they may be worrying about). It is important to first listen and learn rather than to minimize or to tell the child how she should be feeling. As a parent, you want to know what your child knows, and how they feel about it.
Be honest and straightforward. After a suicide, your child may wonder, Who can I trust enough to talk to? There’s nothing that undermines trust as much as the impression that you’re keeping secrets and aren’t telling the truth. Also, when appropriate, be honest about your own feelings.
Communicate you’re willingness and openness to listen to your child if they’re having trouble. Communicate in words and in actions that you are there for your child. And if you can see that your child is suffering, and you’re concerned in any way, seek help from a professional that can consult with you about what your child might need.